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Yaradilmiş RM, Bodur İ, Güneylioğlu MM, Öztürk B, Göktuğ A, Aydin O, Öztoprak Ü, Doğan İ, Güngör A, Karacan CD, Tuygun N. Evaluation of Neurosurgical Emergencies in the Pediatric Emergency Department: Clinical Warning Signs. Pediatr Neurol 2024; 150:107-112. [PMID: 38035464 DOI: 10.1016/j.pediatrneurol.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 04/03/2023] [Accepted: 10/14/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND We aimed to evaluate the patients who underwent neuroimaging with suspicion of neurosurgery pathology and identify the clinical warning signs for the early recognition of neurosurgical emergencies. METHODS Patients aged one month to 18 years who underwent neuroimaging with a preliminary diagnosis of intracranial pathology requiring emergency surgery and symptom duration less than one month were included in the study. Patients were divided into three groups according to their definitive diagnosis as neurosurgical emergencies, neurological emergencies, and nonurgents. RESULTS A total of 140 patients were included in the study (the median age was 8 [interquartile range IQR 3 to 13] years and 52.8% were male). Neurosurgery emergency group and neurological emergency group were significantly younger than the nonurgent group (P < 0.001). Vomiting, meningeal irritation findings, and papilledema (grade 2 and above) were more common in the neurosurgical emergency group (P 0.029, 0.023, and < 0.001, respectively). For neurosurgical emergencies, in the presence of papilledema (grade 2 and above) and focal neurological deficit, the specificity was 99.2%, positive predictive value (PPV) 83.3%, negative predictive value (NPV) 88.1%, and odds ratio (OR) 36.8 (P < 0.001, confidence interval [CI] 4.04 to 336.0); in the presence of altered consciousness and focal neurological deficit, the specificity was 97.5%, PPV 50%, NPV 86.6%, and OR 6.4 (P = 0.014, CI 1.20 to 34.4). CONCLUSIONS Younger age, presence of vomiting, signs of meningeal irritation, papilledema grade 2 and above, and altered consciousness are the crucial "warning signs" of a potential neurosurgical emergency.
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Affiliation(s)
- Raziye Merve Yaradilmiş
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey.
| | - İlknur Bodur
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Muhammed Mustafa Güneylioğlu
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Betül Öztürk
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Aytaç Göktuğ
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Orkun Aydin
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ülkühan Öztoprak
- Department of Pediatric Neurology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - İhsan Doğan
- Department of Neurosurgery, Ankara University Faculty of Medicine, Ibni Sina Hospital, Ankara, Turkey
| | - Ali Güngör
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Can Demir Karacan
- Department of Pediatric Emergency Care, Ankara City Hospital, Ankara, Turkey
| | - Nilden Tuygun
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
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Abstract
The diagnosis and management of neurologic conditions are more complex at the extremes of age than in the average adult. In the pediatric population, neurologic emergencies are somewhat rare and some may require emergent consultation. In older adults, geriatric physiologic changes with increased comorbidities leads to atypical presentations and worsened outcomes. The unique considerations regarding emergency department presentation and management of stroke and altered mental status in both age groups is discussed, in addition to seizures and intracranial hemorrhage in pediatrics, and Parkinson's disease and meningitis in the geriatric population.
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Affiliation(s)
- Danya Khoujah
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S Paca St, 6th Floor, Suite 200, Baltimore, MD 21201, USA; Department of Emergency Medicine, MedStar Franklin Square Medical Center, 9000 Franklin Square Dr, Baltimore, MD 21237, USA.
| | - Megan J Cobb
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S Paca St, 6th Floor, Suite 200, Baltimore, MD 21201, USA; Maryland Emergency Medicine Network, Upper Chesapeake Emergency Medicine, 500 Upper Chesapeake Drive, Bel Air, MD 21014, USA
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Effective Treatment of Traumatic Brain Injury in Rowett Nude Rats with Stromal Vascular Fraction Transplantation. Brain Sci 2018; 8:brainsci8060112. [PMID: 29912146 PMCID: PMC6025091 DOI: 10.3390/brainsci8060112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/15/2018] [Accepted: 06/15/2018] [Indexed: 11/17/2022] Open
Abstract
Traumatic brain injury (TBI) affects 1.9 million Americans, including blast TBI that is the signature injury of the Iraq and Afghanistan wars. Our project investigated whether stromal vascular fraction (SVF) can assist in post-TBI recovery. We utilized strong acoustic waves (5.0 bar) to induce TBI in the cortex of adult Rowett Nude (RNU) rats. One hour post-TBI, harvested human SVF (500,000 cells suspended in 0.5 mL lactated Ringers) was incubated with Q-Tracker cell label and administered into tail veins of RNU rats. For comparison, we utilized rats that received SVF 72 h post-TBI, and a control group that received lactated Ringers solution. Rotarod and water maze assays were used to monitor motor coordination and spatial memories. Rats treated immediately after TBI showed no signs of motor skills and memory regression. SVF treatment 72 h post-TBI enabled the rats maintain their motor skills, while controls treated with lactated Ringers were 25% worse statistically in both assays. Histological analysis showed the presence of Q-dot labeled human cells near the infarct in both SVF treatment groups; however, labeled cells were twice as numerous in the one hour group. Our study suggests that immediate treatment with SVF would serve as potential therapeutic agents in TBI.
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Tude Melo JR, Rocco FD, Blanot S, Oliveira-Filho J, Roujeau T, Sainte-Rose C, Duracher C, Vecchione A, Meyer P, Zerah M. Mortality in Children With Severe Head Trauma: Predictive Factors and Proposal for a New Predictive Scale. Neurosurgery 2018; 67:1542-1547. [PMID: 27759659 DOI: 10.1227/neu.0b013e3181fa7049] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Traumatic brain injury is a public health problem around the world, and recognition of systemic sources of secondary brain lesions is crucial to improve outcome. OBJECTIVE To identify the main predictors of mortality and to propose a grading scale to measure the risk of death. METHODS This retrospective study was based on medical records of children with severe traumatic brain injury who were hospitalized at a level I pediatric trauma center between January 2000 and December 2005. Multiple logistic regression analysis was done to identify independent factors related to mortality. A receiver-operating characteristics curve was performed to verify the accuracy of the multiple logistic regression, and associations that increased mortality were verified. RESULTS We identified 315 children with severe head injury. Median Glasgow Coma Scale score was 6, and median Pediatric Trauma Score was 4. Global mortality rate was 30%, and deaths occurred despite adequate medical management within the first 48 hours in 79% of the patients. Age < 2 years (P = .02), Glasgow Coma Scale ≤ 5 (P < 10), accidental hypothermia (P = .0002), hyperglycemia (P = .0003), and coagulation disorders (P = .02) were all independent factors predicting mortality. A prognostic scale ranging from 0 to 6 that included these independent factors was then calculated for each patient and resulted in mortality rates ranging from 1% with a score of 6 to 100% with a score of 0. CONCLUSION Independent and modifiable mortality predictors could be identified and used for a new grading scale correlated with the risk of mortality in pediatric traumatic brain injury.
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Affiliation(s)
- José Roberto Tude Melo
- 1Departement of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris-France, Université Descartes Paris 5, Paris, France; and Postgraduate Program in Medicine and Health, School of Medicine, Federal University of Bahia, Bahia, Brazil 2Departement of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris-France, Université Descartes Paris 5, Paris, France 3Pediatric Surgical Critical Care Unit and Anesthesiology, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris-France, Université Descartes Paris 5, Paris, France 4Postgraduate Program in Medicine and Health, School of Medicine, Federal University of Bahia, Bahia, Brazil
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Validation of Acoustic Wave Induced Traumatic Brain Injury in Rats. Brain Sci 2017; 7:brainsci7060059. [PMID: 28574429 PMCID: PMC5483632 DOI: 10.3390/brainsci7060059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 05/17/2017] [Accepted: 05/25/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study looked to validate the acoustic wave technology of the Storz-D-Actor that inflicted a consistent closed-head, traumatic brain injury (TBI) in rats. We studied a range of single pulse pressures administered to the rats and observed the resulting decline in motor skills and memory. Histology was observed to measure and confirm the injury insult. METHODS Four different acoustic wave pressures were studied using a single pulse: 0, 3.4, 4.2 and 5.0 bar (n = 10 rats per treatment group). The pulse was administered to the left frontal cortex. Rotarod tests were used to monitor the rats' motor skills while the water maze test was used to monitor memory deficits. The rats were then sacrificed ten days post-treatment for histological analysis of TBI infarct size. RESULTS The behavioral tests showed that acoustic wave technology administered an effective insult causing significant decreases in motor abilities and memory. Histology showed dose-dependent damage to the cortex infarct areas only. CONCLUSIONS This study illustrates that the Storz D-Actor effectively induces a repeatable TBI infarct, avoiding the invasive procedure of a craniotomy often used in TBI research.
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Melo JRT, Di Rocco F, Blanot S, Cuttaree H, Sainte-Rose C, Oliveira-Filho J, Zerah M, Meyer PG. Transcranial Doppler can predict intracranial hypertension in children with severe traumatic brain injuries. Childs Nerv Syst 2011; 27:979-84. [PMID: 21207041 DOI: 10.1007/s00381-010-1367-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 12/08/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the accuracy of emergency Transcranial Doppler (TCD) to predict intracranial hypertension and abnormal cerebral perfusion pressure in children with severe traumatic brain injury (TBI). PATIENTS AND METHODS A descriptive and retrospective cross-sectional study was designed through data collected from medical records of children with severe TBI (Glasgow coma scale ≤ 8), admitted to a level I pediatric trauma center, between January 2000 and December 2005. Early TCD examination was performed upon admission, and TCD profiles were considered as altered using previously validated threshold values for diastolic velocity (<25 cm/s) and pulsatility index (>1.31) or when no-flow/backflow was detected. Invasive intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring were considered as the gold standard to measure intracranial hypertension (ICH). Statistical analyses compared TCD profiles to increased ICP (≥ 20 mmHg) and abnormal cerebral perfusion pressure (<50 mmHg) at admission. RESULTS Non-invasive TCD and ICP monitoring were performed in 117 severe head-injured children. Mean age was 7.6 ± 4.4 years, with a male prevalence (71%). Median initial Glasgow coma scale was 6. TCD had 94% of sensitivity to identify ICH at admission and a negative predict value of 95% to identify normal ICP at admission. Its sensitivity to predict abnormal cerebral perfusion pressure was 80%. CONCLUSIONS The high sensitivity of admission TCD to predict ICH and abnormal CPP after trauma demonstrates that TCD is an excellent first-line examination to determine those children who need urgent aggressive treatment and continuous invasive ICP monitoring.
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Affiliation(s)
- José Roberto Tude Melo
- Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades (Assistance Publique Hôpitaux de Paris, France), Université Descartes Paris 5, Paris, France.
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Scavarda D, Gabaudan C, Ughetto F, Lamy F, Imada V, Lena G, Paut O. Initial predictive factors of outcome in severe non-accidental head trauma in children. Childs Nerv Syst 2010; 26:1555-61. [PMID: 20461522 DOI: 10.1007/s00381-010-1150-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 04/07/2010] [Indexed: 11/30/2022]
Abstract
OBJECT The aim of this study is to evaluate the outcome of young children hospitalized for non-accidental head trauma in our PICU, to evaluate PRISM II score in this sub-population of pediatric trauma and to identify factors that might influence the short-term outcome. MATERIALS AND METHODS Files of all children less than 2 years old with the diagnosis of non-accidental head trauma over a 10-years period were systematically reviewed. We collected data on demographic information, medical history, clinical status, and management in the PICU. Three severity scores were then calculated: PRISM II, Glasgow Coma Scale (GCS), and Pediatric Trauma Score (PTS). Prognosis value of qualitative variables was tested with a univariate procedure analysis (anemia, diabetes insipidus...). Then, quantitative variables were tested with univariate procedure too (age, weight, PRISM II, GCS, Platelet count, fibrin, prothrombin time (PT)...). Potential association between variables and death was tested using univariate procedure. Variables identified by univariate analysis were then analyzed with multivariate analysis through a forward-stepping logistic regression. RESULTS Thirty-six children were included. Mean age was 5.5 months (8 days-21.5 months). Mortality rate was 27.8%. At admission, PTS, PRISM II, GCS, PT, PTT, and diabetes insipidus were significantly altered or more frequent in non survivors. Cutoff value for PRISM II at which risk of mortality increased was 17.5 (sensitivity = 0.8; specificity = 0.88). CONCLUSION PRISM II is a reliable and easy performing tool for assessing the prognosis of non-accidental cranial traumatism in young children. GCS and PTS, scores even simpler than PRISM II, showed good accuracy regarding survival prediction.
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Affiliation(s)
- Didier Scavarda
- Department of Pediatric Neurosurgery, CHU Timone Enfants, 264 rue Saint Pierre, 13385, Marseille cedex 05, France.
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Management of severely injured children in road accidents in France: impact of the acute care organization on the outcome. Pediatr Crit Care Med 2009; 10:472-8. [PMID: 19307817 DOI: 10.1097/pcc.0b013e318198b1cb] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the impact of acute care management on outcome in children severely injured in road accidents. DESIGN AND SETTING Prospective follow-up study conducted in 12 French pediatric intensive care units over a 24-month period. PATIENTS Excluding those in refractory shock or in brain death at admission, a total of 125 children aged <17 years admitted to the pediatric intensive care unit with severe trauma (Injury Severity Score > or =16) were included. RESULTS Intracranial pressure (ICP) monitoring and admission into a trauma resuscitation room (TRR) were used as proxy markers for the center management aggressiveness. Centers which admitted to TRR and monitored ICP when indicated in >75% of cases were called aggressive centers. Children with an ICP monitoring indication admitted to a TRR and monitored, as well as those without an indication treated in a TRR, were judged appropriately managed. A poor outcome at pediatric intensive care unit discharge was defined as a difference between the baseline and discharge pediatric overall performance category above 3, or a hospital death. Children with traumatic brain injury appropriately managed in a less-aggressive center were more likely to have a poor outcome than those appropriately managed in an aggressive center (odds ratio 7.56, 95% confidence interval 1.5-38.4), after adjustment for severity, age, and type of road user. CONCLUSIONS The management in a more aggressive center for children admitted to TRR and monitored for ICP, when indicated, is associated with a better outcome. This could be explained by a more extensive experience in trauma management.
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Scher M. Proposed cross-disciplinary training in pediatric neurointensive care. Pediatr Neurol 2008; 39:1-5. [PMID: 18555165 DOI: 10.1016/j.pediatrneurol.2008.01.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 11/14/2007] [Accepted: 01/14/2008] [Indexed: 11/24/2022]
Abstract
Training and research in pediatric neurointensive care require unique approaches to childhood diseases that reflect differences in the immature brain's response to injury or disease compared with adults. Pediatric neurocritical care is a collaborative effort to provide consultative care among pediatric subspecialists, coordinated by neonatal and pediatric intensivists. Valuable perspectives for clinical care, training, and research can also be learned through collaboration with adult neurointensivists. Pediatric neurointensive care is thus an emerging subspecialty that optimally functions by applying a broad collaborative effort among colleagues across multiple medical specialties in pediatric and adult medicine. Innovations in clinical services, educational pathways, and research agendas need to be developed for children that can be modified for younger and older adults. This review also stresses cross-disciplinary research and training opportunities in pediatric neurointensive care beyond physician training. Nonmedical faculty from multiple academic disciplines should also serve as mentors to design appropriate curricula and research plans for the specific trainee in their respective fields and across specialties. The discipline of neurocritical care must consider a life-course approach for the patient requiring neurointensive care from neonatal through childhood and adult ages, with cross-fertilization from diverse academic disciplines and investigative points of view.
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Affiliation(s)
- Mark Scher
- Division of Pediatric Neurology, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
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Sigmund GA, Tong KA, Nickerson JP, Wall CJ, Oyoyo U, Ashwal S. Multimodality comparison of neuroimaging in pediatric traumatic brain injury. Pediatr Neurol 2007; 36:217-26. [PMID: 17437903 DOI: 10.1016/j.pediatrneurol.2007.01.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Accepted: 01/02/2007] [Indexed: 11/28/2022]
Abstract
Traumatic brain injury is a common cause of death and disability in children; early neuroimaging has assumed an increasingly important role in evaluating the extent and severity of injury. Several imaging methods were assessed in a study of 40 children with traumatic brain injury: computed tomography (CT), T(2)-weighted magnetic resonance imaging (MRI), fluid-attenuated inversion recovery (FLAIR) MRI, and susceptibility-weighted imaging (SWI) MRI to determine which were most valuable in predicting 6-12 month outcomes as classified by the Pediatric Cerebral Performance Category Scale score. Patients were subdivided into three groups: (1) normal, (2) mild disability, and (3) moderate/severe disability/persistent vegetative state. T(2), FLAIR, and SWI showed no significant difference in lesion volume between normal and mild outcome groups, but did indicate significant differences between normal and poor and between mild and poor outcome groups. Computed tomography revealed no significant differences in lesion volume between any groups. The findings suggest that T(2), FLAIR, and SWI MRI sequences provide a more accurate assessment of injury severity and detection of outcome-influencing lesions than does CT in pediatric traumatic brain injury patients. Although CT was inconsistent at lesion detection/outcome prediction, it remains an essential part of the acute traumatic brain injury work-up to assess the need for neurosurgic intervention.
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Affiliation(s)
- Geoffrey A Sigmund
- Loma Linda University School of Medicine, Loma Linda, California 92354, USA
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van der Kouwe AJW, Burgess RC. Neurointensive care unit system for continuous electrophysiological monitoring with remote web-based review. IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE : A PUBLICATION OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY 2003; 7:130-40. [PMID: 12834169 DOI: 10.1109/titb.2003.811873] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is a need in the neurological intensive care unit for a single integrated bedside monitor for continuously monitoring the function of the patient's central nervous system. In this paper, we demonstrate the feasibility of building such a system and operating it in the intensive care environment. We have developed a fully automated system that samples electrophysiological waveforms of various modalities according to a schedule of predefined intervals along with routinely monitored cardiac and respiratory parameters. The system provides stimulation and acquires responses without requiring supervision. The electrophysiological data include brainstem auditory and somatosensory evoked potentials and epochs of the electroencephalogram. The system applies peak detection and spectral analysis to extract salient parameters from the raw waveforms. The results are made available immediately in real time on the local network for local review and further analysis. A web-based interface makes review by a qualified neurologist possible anywhere within the hospital's secure intranet during and after monitoring. This system could potentially give an early warning of impending herniation, subclinical seizures, and brain or spinal cord ischemia. We demonstrate its application in a few diverse neurological intensive care cases and a case in the interventional neuroradiology suite.
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Meyer P, Orliaguet G, Blanot S, Cuttaree H, Jarreau MM, Charron B, Carli P. [Anesthesia-resuscitation for intracranial expansive processes in children]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2002; 21:90-102. [PMID: 11915482 DOI: 10.1016/s0750-7658(01)00517-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The most frequent space-occupying cerebral lesions in children are brain tumors, mostly posterior fossa tumors and haematoma resulting from arteriovenous malformation rupture. They result in intracranial hypertension, directly or by compression of the cerebrospinal fluid pathway resulting in hydrocephalus. Their localization and compressive effects are responsible for specific neurological deficits and general problems. Posterior fossa lesions carry a high risk of obstructive hydrocephalus, cranial nerves palsy and brain stem compression, pituitary and chiasmatic tumors a risk of blindness, pituitary deficiency and diabetes insipidus, and cortical tumors a risk of motor deficit and epilepsy. All these parameters must be analyzed before choosing anaesthetic protocols, and surgical techniques. In the presence of life-threatening intracranial hypertension, emergency anaesthetic induction, tracheal intubation and ventilation are life-saving. The specific treatment consists in either hydrocephalus derivation, initial medical treatment with osmotherapy, or rarely surgical removal. In other situations, surgical process requires a highly deep, stable anaesthesia with perfect control of cerebral haemodynamics. Surgical positioning is complex for these long lasting procedures and carries specific risks. The most common is venous air embolism in the sitting position that must be prevented by the use of specific measures. In the postoperative period, the risk of neurological and general complications commands close surveillance, fast track extubation must be adapted on an individual basis.
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Affiliation(s)
- P Meyer
- Département d'anesthésie-réanimation chirurgicale, secteur pédiatrique, CHU Necker-Enfants Malades, 149, rue de Sèvres 75015 Paris, France.
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